TY - JOUR
T1 - Temporal Trends in Mortality and Hospitalization Risk in Patients With Heart Failure According to the Hospital Frailty Risk Score
AU - Abassi, Noor K
AU - Nouhravesh, Nina
AU - Elmegaard, Mariam
AU - Austreim, Marte
AU - Zahir, Deewa
AU - Garred, Caroline Hartwell
AU - Butt, Jawad H
AU - Andersen, Camilla Fuchs
AU - Strange, Jarl E
AU - Sindet-Pedersen, Caroline
AU - Christensen, Daniel M
AU - Fosbøl, Emil
AU - Andersson, Charlotte
AU - Køber, Lars
AU - Schou, Morten
PY - 2025/2/4
Y1 - 2025/2/4
N2 - BACKGROUND: Heart failure (HF) and frailty often coexist. However, it is unknown how the interplay between HF and frailty at HF onset impacts prognosis of frail patients with HF and how this has evolved over time.METHODS AND RESULTS: We identified 131 235 patients with new-onset HF (median age 74 years, 39.7% women) from Danish nationwide registers in 1999 to 2017. Stratification according to the Hospital Frailty Risk Score resulted in (1) 102 635 (78%) nonfrail, (2) 26 054 (20%) moderately frail, and (3) 2609 (2%) severely frail patients. The proportion of moderately frail patients increased from 13.2% to 24.9%. Five-year absolute risks of all-cause mortality, HF hospitalization, and non-HF hospitalization were calculated using the Kaplan-Meier and Aalen-Johansen estimators. From 1999 to 2002 to 2003 to 2017, all-cause mortality risk (95% CI) declined from 56.4% (55.8%-57.0%) to 33.3% (32.6%-34.1%), 79.8% (78.5%-81.0%) to 58.6% (57.2%-60.1%), and 90.8% (85.6%-96.0%) to 79.8% (76.4%-83.2%) in nonfrail, moderately frail, and severely frail patients, respectively. HF hospitalization risk remained almost constant over the study period. Non-HF hospitalization risk declined from 74.0% (73.5%-74.5%) to 65.8% (65.0%-66.5%) in nonfrail patients and remained stable overall in moderately frail and severely frail patients over the study period.CONCLUSIONS: We observed an increase in frail patients. Mortality decreased for all frailty groups but remained high for severely frail patients. These findings indicate the need for further evidence on the optimization of care for frail patients with HF, and future research should address the development of comprehensive management strategies, integrating frailty assessment into standard clinical care and focused care for older patients with HF.
AB - BACKGROUND: Heart failure (HF) and frailty often coexist. However, it is unknown how the interplay between HF and frailty at HF onset impacts prognosis of frail patients with HF and how this has evolved over time.METHODS AND RESULTS: We identified 131 235 patients with new-onset HF (median age 74 years, 39.7% women) from Danish nationwide registers in 1999 to 2017. Stratification according to the Hospital Frailty Risk Score resulted in (1) 102 635 (78%) nonfrail, (2) 26 054 (20%) moderately frail, and (3) 2609 (2%) severely frail patients. The proportion of moderately frail patients increased from 13.2% to 24.9%. Five-year absolute risks of all-cause mortality, HF hospitalization, and non-HF hospitalization were calculated using the Kaplan-Meier and Aalen-Johansen estimators. From 1999 to 2002 to 2003 to 2017, all-cause mortality risk (95% CI) declined from 56.4% (55.8%-57.0%) to 33.3% (32.6%-34.1%), 79.8% (78.5%-81.0%) to 58.6% (57.2%-60.1%), and 90.8% (85.6%-96.0%) to 79.8% (76.4%-83.2%) in nonfrail, moderately frail, and severely frail patients, respectively. HF hospitalization risk remained almost constant over the study period. Non-HF hospitalization risk declined from 74.0% (73.5%-74.5%) to 65.8% (65.0%-66.5%) in nonfrail patients and remained stable overall in moderately frail and severely frail patients over the study period.CONCLUSIONS: We observed an increase in frail patients. Mortality decreased for all frailty groups but remained high for severely frail patients. These findings indicate the need for further evidence on the optimization of care for frail patients with HF, and future research should address the development of comprehensive management strategies, integrating frailty assessment into standard clinical care and focused care for older patients with HF.
KW - Aged
KW - Aged, 80 and over
KW - Cause of Death/trends
KW - Denmark/epidemiology
KW - Female
KW - Frail Elderly/statistics & numerical data
KW - Frailty/mortality
KW - Geriatric Assessment
KW - Heart Failure/mortality
KW - Hospitalization/trends
KW - Humans
KW - Male
KW - Prognosis
KW - Registries
KW - Risk Assessment
KW - Risk Factors
KW - Time Factors
KW - heart failure
KW - time trend
KW - frailty
KW - hospitalization risk
KW - all-cause death
UR - http://www.scopus.com/inward/record.url?scp=85218069309&partnerID=8YFLogxK
U2 - 10.1161/JAHA.124.037973
DO - 10.1161/JAHA.124.037973
M3 - Journal article
C2 - 39895527
SN - 2047-9980
VL - 14
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 3
M1 - e037973
ER -